Metabolic Acidosis
This summary is based on posts and comments shared on Reddit.Disclaimer
Users on Reddit have reported experiences with metabolic acidosis, primarily in the form of Diabetic Ketoacidosis (DKA), while on GLP-1 medications. These discussions often involve individuals with Type 1 diabetes or those experiencing other complications like pancreatitis. The remedies and preventions mentioned are largely centered on medical supervision, careful patient selection, and management of contributing factors rather than self-administered remedies for DKA itself, which is a serious medical condition requiring professional care.
Experiences with Metabolic Acidosis (Diabetic Ketoacidosis - DKA):
Medical professionals on Reddit have also shared observations of DKA in patients on GLP-1s. An emergency doctor mentioned a "patient with pancreatitis, DKA after about 3 weeks on meds, admitted for a second time after re-starting his GLP-1". [2]
Another severe case described involved a Type 1 Diabetic where "Pancreatitis -> couldn’t eat -> didn’t use their insulin (Type 1 Diabetic) -> DKA -> new a fib -> stroked -> on CRRT for some time. "[3]
One user reported a patient with a very high A1C (13+) who, after being started on full-dose Metformin and a GLP-1, was "admitted to ICU for DKA, so hypovolemic from GI side effects she needed a pressor, and pancreatitis presumably from GLP1. "[4]
Concerns and Pathophysiology (Primarily from medical perspectives in the data):
A detailed explanation was provided by another user regarding the risks for Type 1 Diabetics: "Suppressing glucagon in T1DM patients can impair this counter-regulatory safety mechanism... delayed gastric emptying can delay the absorption of carbohydrates and lead to mismatched insulin dosing... appetite suppression decreases PO intake and for T1DM patients, this could lead to insufficient insulin coverage for fat metabolism, triggering DKA". [6]
Another user emphasized, "GLP1s in Type 1s is already risky". [7]
Remedies and Preventions (Mostly implied or from a medical standpoint):
Caution in Specific Populations: Medical professionals advise caution and careful consideration when prescribing GLP-1s to Type 1 Diabetics due to the potential for DKA. [5, 6, 7]
Managing Underlying Triggers: For the user who developed ketones from rapid fat loss, the issue resolved when their "weight stabilized," suggesting that managing the rate of weight loss or allowing physiological adaptation under medical guidance can be a factor. [1]
Ensuring Proper Insulin Management: The critical role of continued and appropriate insulin therapy is underscored by the DKA case where the patient "didn’t use their insulin". [3] This is especially crucial if food intake is reduced.
Addressing GI Side Effects: Since severe GI side effects leading to hypovolemia contributed to DKA in one instance, managing these side effects to prevent dehydration is important.
Experiences with Metabolic Acidosis (Diabetic Ketoacidosis - DKA):
- Some users, particularly those with Type 1 diabetes, have reported developing ketones or DKA.
Concerns and Pathophysiology (Primarily from medical perspectives in the data):
- The risk of DKA with GLP-1s in Type 1 Diabetics is a recurring theme.
Remedies and Preventions (Mostly implied or from a medical standpoint):
- Close Medical Supervision: The importance of being in "constant touch with my endo" was highlighted by the Type 1 diabetic user who developed ketones.